The relationships between viscera imply the inter-relationship between the five zangviscera. In ancient times, TCM always applied the theory of inter-generation and interrestraint of the five elements to explain the physiological relationships between the five zang-viscera, and applied the theory of the over-restraint and counter-restraint of the five elements to explain pathological influence between the five zang-viscera. But, in fact, the inter-generating, inter-restraining, over-restraining, and counter-restraining relations of the five elements are not enough to explain the complicated relationships between the five zang- viscera. In the following, these relationships will be discussed with an emphasis on their physiological relationships and pathological inter-influence.
1. The Heart and the Lung
The heart dominates blood, and the lung controls qi. The heart-blood and lung-qi
depend on each other. So, the relationship between the heart and lung is mainly related with qi and blood.
1) Lung-Qi Aiding the Heart's Function of Propelling Blood
The heart dominates the blood vessels, which propel circulation of the blood. The normal circulation of the blood must depend on the aid of lung-qi Lung-qi helps the heart promote circulation of the blood through the function of the pectoral qi. The pectoral qi is formed by combination of clear qi inhaled by the lung and the essential qi from food and drink, and is stored in the chest. Pathologically, deficiency of pectoral qi caused by weakness of lung-qi will lead to weakness and stagnation of the blood circulation, giving rise to stuffiness in the chest, shortness of breath, palpitation, and purplish lips. Hence, the ancients said, "Qi is the commander of the blood," "Free flow of qi leads to blood circulation," and "Stagnation of qi causes blood stasis. "
2) Heart-Blood Transporting Lung-Qi to Distribution
The lung dominates qi and controls respiration. The pectoral qi is a combination of the clear qi inhaled from the natural environment and food essence, and only by relying on transportation by the blood can it be distributed to the entire body. Thus, the ancients said, "The blood is the mother of qi. " Therefore, disorders of the heart can affect the blood circulation, impairing the dispersing function of the lung and causing stagnation.This impedes respiration, characterized by stuffiness in the chest, shortness of breath,cough, asthma, and dyspnea. Pulmonary heart disease and pulmonary congestion due to cardiac failure in modern medicine are concrete example of conditions caused by the heart and lung affecting each other in pathological changes.
In addition, both the heart and lung are located in the upper-jiao. During the deve opment of heat diseases, when warm-heat evil invades the body, the lung is first to be at fected, making its function abnormal. Furthermore, the heart is disturbed, leading symptoms of mental derangement.
2. The Heart and the Spleen
The relationship between the heart and spleen is mainly demonstrated in the formation and circulation of blood.
1) Blood Formation
Physiologically, the heart dominates the blood, while the spleen dominates trans
portation and transformation, and represents the source for growth and transformation qi and blood. If spleen-qi is abundant, there will be an adequate source for growth an transformation of blood, and the heart will be nourished by ample blood, thus maintaining its functions. The function of the spleen in producing blood and transporting and distributing the essential substance depends on the propelling force of yang-qi of the heart.That is to say that heart-fire warms spleen earth (i. e. , the fire generates the earth in the theory of the five elements). Pathologically, they also often affect each other. For example, an insufficiency of the source of blood due to deficiency of spleen-qi may cause consumption of heart-blood. Conversely, over-thinking, which consumes heart-blood, may affect the function of the spleen in transportation and transformation, eventually resulting
in the syndrome of "deficiency of both the heart and spleen," with such manifestations as palpitation, insomnia, poor appetite, lassitude, and a pale complexion. Treatment in clinical practice often involves the use of spleen-qi-invigorating and heart-blood-nourishing methods.
2) Blood Circulation
Normal circulation of blood needs to be performed by a common effort of a number
of internal organs, as well as the coordination of the heart and spleen. The heart propels the circulation of blood, and the spleen commands blood, i.e., it has the function of keeping it flowing within the vessels. Pathologically, the heart and spleen often affect each other. The disturbance of heart may not only cause excessive burden on the blood but also affect the transportation and transformation of the spleen. Conversely, hemorrhaging due to the failure of splenic management of the blood can result in the insufficiency of heart-blood. Such conditions are known as deficiency of both the heart and spleen,and clinical manifestations are dizziness, palpitation, poor memory, insomnia, lusterless complexion, and poor appetite.
3. The Heart and the Liver
The relationship between the heart and liver is mainly manifested in the blood circulation and the mental and emotional activities.
1) Blood Circulation
The heart dominates the blood, which is stored by the liver. If the blood is abundant, the heart has its object of domination and the liver has its object of storage. This ensures the normal physiological functions of the heart and liver. In addition, the blood is stored by the liver and is moved by the heart, and both organs work in coordination to regulate its volume in order to meet the physiological needs of the body. Pathologically,the heart and the liver affect each other. Disorders of the heart and liver are often manifested in dysfunction of the blood. An insufficiency of heart-blood often leads to impairment of liver-blood, and conversely, deficiency of liver-blood also causes deficiency of heart-blood. In such a case, both the heart and liver lack in nourishment of blood, giving rise to palpitations, insomnia, dizziness, blurred and impaired vision, oligomenorrhea, or
delayed menstruation.
2,) Mental and Emotional Activities
The liver dominates the conducting and dispersing functions, and regulates the emotions, while the heart houses the mind which dominates the mental activity. Thus both the heart and liver are in relation with mental, conscious, and thinking activities. Only when the heart and liver are in harmony can the mental and emotional activities be normal. Disturbances of the heart and liver usually lead to changes in the mind and emotions; for example, exuberance of heart-fire and liver-fire usually result in derangement of the mind, and symptoms such as mental restlessness, insomnia, irritability, weeping and laughing without apparent reason, or incoherent speech.
4. The Heart and the Kidney
The heart is located in the upper and belongs to yang, and corresponds to fire; the kidney is located in the lower and pertains to yin and water. Thus, the relationship between the heart and kidney is concretely manifested in the following three aspects.
1) The Harmony between the Heart and the Kidney
Under normal conditions, a relative balance between above and below, yin and
yang, and water and fire, is maintained. This ensures the normal physiological functioning of the heart and kidney. The relative balance of the heart and kidney is shown in the interaction of heart-yang and kidney-yang downwards, and the interaction of kidney-yin and heart-yin upwards. Under normal physiological conditions, heart-yang must descend into the kidney, together with the kidney-yang, to warm kidney-water, so that the kidney-water will not be cold-deficient. At the same time, kidney-yin must ascend into the heart, together with heart-yin, to moisten heart-yang so that it will not be hyperactive. This relationship of mutual communication and restriction is known as "the harmony between the heart and kidney," or "mutual support of water and fire. "
The heart and kidney inter-depend and influence each other. In pathology, eithe
the heart or the kidney is in imbalance of yin and yang, and disrupts the relationship of"harmony between the heart and kidney," resulting in the syndrome of the "discord of the heart and kidney. " For example, when heart-yang is deficient, heart-fire is unable to descend into the kidney, and kidney-yang fails to evaporate fluids, causing an over-flow of water to attack the heart, and giving rise to palpitation, edema, and so on. Such a condition is called"pathogemc water insultmg the heart. " When kidney-yin is insufficient, i. e. , when it is unable to ascend to nourish heart-yin, or deficient kidney-yang fails to evaporate kidney-yin to moisten heart-yin, this deficiency results in the failure of yin to restrain yang. This causes ascendant hyperactivity of heart-yang, characterized by
mental restlessness, insomnia, dream-disturbed sleep, and seminal emission. This is called discord of the heart and kidney.
2) The Essence and Blood Promoting Each Other
The heart dominates blood and the kidney stores the essence. The essence can manu facture blood, which in turn can be transformed into the essence. The two nourish each other. Thus, under pathological states, impairment of the kidney essence and insufficiency of heart-blood are interconnected, one being the cause or effect of the other.
3) Regulating Mental and Emotional Activities
The heart stores the mind, which dominates the mental, conscious, and thinkin
activities; while the kidney stores the essence and the will, and accumulation of the essence can perfect the spirit. The kidney-stored essence also engenders the marrow to fill up the brain, and is the material basis of the mental and emotional activities. Only whet the functions of both the heart and the kidney are in coordination can mental and emotional activities be normal. Either deficiency of heart-blood or of kidney-essence, there fore, may lead to the disturbance of consciousness, and such symptoms as mental rest lessness, insomnia, poor memory, dream-disturbed sleep, dizziness, vertigo, and listless ness.
5. The Spleen and the Lung
The spleen's relationship to the lung mainly centers on the formation of qi and water metabolism.
1) The Formation of Qi
The spleen is considered to be the source for growth and transformation of qi. The lung dominates qi and controls respiration. Coordination of the spleen and lung lays foundation for formation of acquired qi and provides conditions of pectoral qi formation Yin-fluid and qi of the lung also need the supplement of the essential substance of drink and food that are transported and transformed by the spleen. The prosperity or decline of lung-qi, therefore, relies greatly on the strength of spleen-@ Thus, there are sayings that "the spleen is the source of the qi formation and "the lung is the pivot of dominating qi. " In addition, the depurative descending function of the lung-qi promotes flow of water downwards and excretion, which is beneficial to the spleen's function, because the spleen dislikes dampness.
So, it can be seen that the spleen and lung are inter-coordinated and inter-supporting in their physiology. If they are diseased, they often influence each other. If spleen-qi is impaired, it fails to aid the lung, and a deficiency of lung-qi results. This leads to deficiency of both the lung and the spleen, such manifestations as poor appetite, abdominal distension, loose stools, cough, shortness of breath, lassitude, and so on. This condition is called "the earth is unable to produce the metal. " A long-lasting deficiency of lung-qi may cause failure of dispersing functions, as it fails to distribute the essence and fluids to
the whole body so that a deficiency of spleen-qi results; this is another cause of "deficiency of both the lung and spleen. "
2) The Water Metabolism
The spleen transports and transforms water-dampness, and the lung is the upper
source of water and regulates water passage. Hence, coordination of the lung and spleen plays an important role in maintaining the balance of water metabolism. They share the work and cooperate with one another to keep coordinating actions. The mutual influence of the lung and spleen in pathology is frequently manifested in the disturbance of water metabolism. For example, if splenic transportation and transformation is impaired, water-dampness may accumulate and turn into fluid-retention or phlegm. Retention of phlegm can obstruct the lung, and this will affect the lung's function of dispersing and depurative descending, causing stuffiness in the chest, cough, and sputum. Thus, it is :said, "The spleen is the source of phlegm formation, while the lung is the container of phlegm. " A long-lasting lung disorder may also affect the function of the spleen. For ex-
ample, failure of the lung in dispersing and depurative descending may lead to accumulation of water-dampness in the middle-jiao, and the spleen will be encumbered, resulting in edema, lassitude, abdominal distension, and loose stools.
6. The Lung and the laver
The relationship between the lung and liver mainly manifests in ascending and Mending of functional activity of qi. The lung is located in the upper-jiao, and its qi has the function of depurative descending; the liver is in the lower-jiao, and its qi has the function of dispersing and ascending. Thus, there is a saying that "the liver-qi ascends from the left, while the lung qi descends from the right. " Only when liver-qi normally ascends and lung-qi normally descends, can the functional activities of the body be maintained for normal life activities.
The Liver Meridian passes through the diaphragm and goes into the lung from the lower portion, thus the liver and lung are in coordination in physiology, and inter-influencing in pathology. If liver-qi is depressed, it may transform into the fire which goes upward along the meridian to consume the lung-fluid, leading to hypochondriac pain, irritability, cough, and hemoptysis. Such a condition is known as "wood-fire causing metal to suffer," or in other words, "invasion of the lung by liver-fire. " Conversely, dysfunction of the lung in depurative descending may cause dryness-heat evil that descends to affect the liver, resulting in failure of the liver in dominating the conducting and dispersing.In this case, in addition to cough, there may be pain in the chest and hypochondriac region, irritability, dizziness, and headache.
7. The Lung and the Kidney
The relationship between the lung and the kidney is manifested in the following three aspects
1) Water Metabolism
The kidney is a viscus dominating water metabolism and it has the transformative
function of qi, which can send up the clear and send down the turbid. The lung is the upper source of water, and it has the function of dispersing and depurative descending, and regulating the water passages, which makes water in the upper-jiao come into the kidney. Only through the evaporating and transformative functions of kidney-qi can the clear be sent up, the clear fluid flow back throughout the body via the function of the triplejiao, and the turbid fluid be turned into urine and carried down to the urinary bladder.Thus, the lung and kidney work in coordination to maintain the balance of water metabolism. Pathologically, dysfunction of the lung and kidney may not only affect normal water metabolism, but also influence each other. For example, failure of the transformative function of kidney-qi may lead to retention of water, which will overflow into the lung, causing disturbance of the lung's functions, known as "cold-water shooting in the lung," with manifestations such as edema, severe cough, asthmatic breathing, and soon.
2) Respiration
The lung dominates the qi and controls respiration, and the kidney dominates the reception of qi. Although the respiration belongs to the functioning of the lung, it is nevertheless dependent on the action of receiving qi of the kidney in one aspect. Only when the kidney's essential qi is vigorous can the clear qi inhaled from the natural world be sent downward through depurative descending of the lung, and be received by the kidney to maintain even and deep respiration. Thus, in the Ming Dynasty, Zhang Jingyue said:"The lung is the governor of qi, while the kidney is the root of qi. " Disturbance of the lung and kidney often affects respiratory functions. For example, when the essential qi of the kidney is deficient, and fails to receive qi, the qi will remain floating above; or when prolonged deficiency of lung-qi affects kidney-qi, there will be "failure of the kidney in receiving qi. " These conditions result in respiratory insufficiency characterized by cough,
shortness of breath, asthma, rapid breathing at the slightest exertion, and dyspnea. The only effective treatment for such cases is the method of reinforcing the kidney to improve the reception of qi.
3) The Yin-Fluids of the Lung and the Kidney Nourishing Each Other
Kidney-yin is the root of yin-fluid of the whole body, and has the function of nourishing and supplementing the yin of all internal organs. Kidney-yin can thus support and nourish the lung, and lung-yin will be in abundance. Similarly, yin-essence of the upperjiao is carried downwards into the kidney by the lung's function of depurative descending, so that kidney-yin will be replenished. Hence, yin-fluids of the lung and kidney nourish and supplement each other. Such conditions are termed "the metal and the water are inter-generating. "
Pathologically, deficiency of lung-yin may injure kidney-yin and deficiency of kidney-yin may fail to nourish lung-yin. Either state may lead to yin deficiency of both the lung and kidney, characterized by weakness and soreness of the lumbar and knees, tidal fever, hoarse voice, malar flush, night sweats, dry cough with little sputum, seminal emission, irregular menses, and so on.
8. The Liver and the Spleen
The relationship between the liver and spleen is mainly reflected in the digestion of diet and the formation and storage of the blood.
1 ) Digestion
The normal digestive process of the body is performed by a number of viscera. Among them, the coordination of the liver and spleen plays a particularly important role.The normal function of the spleen and stomach in ascending and descending is dependent on the regulation of the liver in dominating the free-flowing of qi. When the liver performs this function normally, the spleen and stomach will be coordinated to ensure normal digestion, absorption, and distribution of food. In addition, the spleen is the acquired foundation and the source of the formation of essential substances. When the spleen functions well in transporting and transforming drink and food, the essential substance of drink and food is carried continuously to the liver. Thus, the liver is nourished and functions well in dominating the conducting and dispersing functions.
Dysfunction of the liver and spleen may not only affect normal digestion, but also influence each other, and then lead to disturbances of the digestive system. For example, if the liver fails to perform its function in dominating the conducting and dispersing functions, the splenic function will be affected, causing a fullness sensation in the chest, and hypochondria, poor appetite, abdominal distension after eating, belching and discomfort abdominal pain, and diarrhea. Such a condition is termed "disharmony between the live and spleen. " In addition, if the spleen fails to transport and transform water-dampness, the heat engendered by dampness accumulates, and damp-heat fumes and steams the liver and the gallbladder, leading to a failure of the functions of conducting and dispersing; as a result, the bile overflows to the skin, and jaundices occur. This condition is known as "the jammed earth counter-restraining the wood. "
2) The Formation, Storage, and Circulation of the Blood
The liver is capable of retaining blood and regulating the amount of blood in the body, while the spleen commands the blood and is the source for growth and transformation of qi and blood. When spleen-qi is vigorous, it has a rich source for blood production, the liver has its object of storage, and liver-blood will be abundant. The liver and spleen work in coordination to maintain the normal circulation of blood to satisfy the needs of the body. Disorders of the liver and spleen may lead to the syndrome of bleeding and deficiency of blood. For example, if the spleen fails to perform its function of transporting, and the source for growth and transformation of the qi and blood is insufficient or if the spleen fails to command the blood, there will be a deficiency of liver-blood producing symptoms such as bleeding, poor appetite, emaciation, blurred vision, and oligomenorrhea or amenorrhea.
9. The Spleen and the Kidney
The spleen is the foundation of acquired constitution, while the kidney is the foundation of congenital constitution. Therefore, the relationship between the spleen and kidney is demonstrated in mutual nourishment of the congenital essence and acquired essence.
The spleen plays an important role in digestion and absorption of the diet. By relying on the warming and evaporating function of kidney-yang, the spleen can ensure the nor mal digestive function of the body. Kidney-essence constantly needs to be replenished by the essential substances transported by the spleen. Thus, the congenital promotes the ac quired and the acquired nourishes the congenital. These two organs promote and aid each other in physiology. Pathologically, they also affect each other. For example, when kidney-yang fails to warm spleen-yang, there will be a deficiency of spleen-yang; long-term deficiency of spleen-yang may further impair the kidney and result in deficiency of kidney yang which will eventually lead to yang deficiency of both the spleen and kidney, with clinical manifestations including cold and painful sensations in the abdomen, daybreak diarrhea, watery stools mixed with undigested food, edema, soreness and pain of the lumbar region and knees, and aversion to"cold and cold limbs.
Since the spleen transports and transforms water-dampness, and is responsible for the transformative action of qi, it works in coordination with the kidney to promote and regulate water metabolism. When the spleen and kidney are diseased, they fail to perform this function and cause disturbance of water metabolism, giving rise to difficulty in urination, edema, and so on. Such a condition is termed "an overflow of water due to a deficient yang. " The method of "warming yang to excrete water" often is used in clinical treatment.
10. The Liver and the Kidney
The relationship between the liver and the kidney mainly centers upon the fact that"the liver and kidney share the common source" and the inter-connection of yin and yang.
1) The Common Source of the Liver and Kidney
This phrase indicates that the physiological functions of both the liver and kidney take the essence and blood as their material bases. The liver stores the blood, while the kidney stores the essence. The essence can engender the blood, and the blood in turn transforms into the essence. Liver-blood depends on nourishment from kidney-essence,and abundance of kidney-essence may lead to the sufficiency of liver-blood; meanwhile,kidney-essence depends on replenishment from liver-blood, and sufficiency of liver-blood may also lead to abundance of kidney-essence. Since they are inter-generating and intertransforming, they also originate from the essential substances of food and drink, and for this reason it is said that, "the liver and kidney share common source. " Another meaning of this phrase denotes that both contain the "primer fire" or "monarch fire. " The "primer fire" contained in the liver and kidney originates from the vital gate. Thus, there is another saying that "Both the liver and kidney originate from the vital gate. "
2) Coordination of the Yin and Yang in the Liver and Kidney
Kidney-yin is the root of yin-fluid of the entire body. It nourishes liver-yin and keeps the balance of yin-yang of the kidney itself. Liver-yin is reinforced by kidney-yin,and abundance of liver-yin can control liver-yang to prevent it from becoming ascendant hyperactivity. This maintains the counter-balance of yin and yang of the liver. As liveryin and kidney-yin are closely related in physiology, they often influence each other in pathology. For example, when deficiency of kidney-yin deprives the nourishment of liver-yin, it leads to yin deficiency of both the liver and kidney. Clinical manifestations inelude soreness and weakness of the lumbar region and back, dizziness, vertigo, and dryness of the eyes. A hyperactivity of the liver-yang, in turn, consumes kidney-yin, producing the syndrome of hyperactivity of yang due to yin deficiency. It is termed "water failing to nourish wood. " Clinical manifestations may be headache, redness of the eyes,dizziness, tinnitus, irritability, soreness and pain of the lumbar region, seminal emission,
and so on. In therapy, whether it is deficient syndrome or excess syndrome, the reinforcing and purgative methods are often used in combination.

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